Claims Supervisor

We exist for workers and their employers -- who are the backbone of our economy.  That is where the company comes in -- our mission is to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills.

The company is seeking a Claims Supervisor to lead a team of Claims Processors, ensuring accurate and efficient claims processing for employer-sponsored health plans. This role sets productivity benchmarks, enforces quality standards, and drives continuous improvement.

The Claims Supervisor will collaborate with support teams to manage backlog and turnaround times while working with Quality/Training and System Configuration teams to standardize processes and resolve issues. They may also oversee appeals, subrogation, and overpayment/refunds, ensuring compliance and efficiency.

Responsibilities Include

• Demonstrates knowledge and understanding of benefit administration for self-funded healthcare plans

• Ensures that claims are processed and paid in accordance with benefit plans, pricing agreements, and required authorizations

• Manages the inventory of claims against standard service level agreements (SLAs)

• Educates and mentors claims staff to ensure proper application of client benefit plans to claims processed, at the required quality and production metrics, including establishing performance plans for those falling below expectations with appropriate coaching and mentoring to achieve improvement

• Provides reports to department leaders on claim inventory, production, turn-around lag, and quality metrics

• Develops policy and procedures to ensure that benefit plans and claim standards are properly administered; assists in developing policies and procedures for operations, and monitors claim staff for compliance

• Accountable for positively influencing the morale of the department employees, including setting achievable goals, fostering teamwork by involving team in the design/implementation of solutions to problems

• Responsible to establish annual goals for staff that align with organization strategies and personal growth and can provide timely and constructive feedback on performance

• Is a liaison for the claims on various projects and/or initiatives including testing needs to support system implementations and/or upgrades

• Performs other duties as deemed essential and necessary

Qualifications

Required Skills and Abilities

• Knowledge: Thorough understanding of insurance policies, claims handling processes, and legal requirements associated with claims.

• Leadership: Strong leadership and team management skills, with the ability to effectively manage and motivate a team.

• Analytical Skills: Ability to analyze claims data and make informed decisions based on findings.

• Experience: Previous experience in claims processing or a related field, including supervisory experience.

• Understands health insurance benefit administration in a Self-Funded environment

• Ability to read and understand various forms, documentation, files, and information with the department.

Education and Experience

• Candidate must have at least 3 years of experience with self-funded health care plans and processing in a TPA environment

• Candidate must have at least 3 years of experience supervising a claims team

• Candidates must have prior experience with a highly automated and integrated claim adjudication system

• Experience working with HealthRules Payer

• Understanding of health insurance benefits administration in a self-funded environment

Preferred Qualifications

• Past Training Experience

• Experience working at TPA

• Experience with self-funded plans

Work Location

• An ideal candidate would be assigned to the Buffalo Office with ability to work from home.

• If not in the Buffalo area, the opportunity can be remote.

Leadership Skills & Behaviors

• Strategic Thinking: Ability to sort through clutter to find the best route by identifying patterns in complexity, guiding future direction, narrowing options, and articulating choices for others to use.

• Business Acumen: Quick understanding and handling of business situations, considering both risks and opportunities, with awareness extending beyond one's own function.

• Systems/Analytical Thinking: Capacity to integrate information, anticipate non-linear and non-obvious relationships, and think holistically/conceptually, combined with tactical communication and clarification skills.

• Flexibility/Working through Ambiguity: Energized by new experiences and perspectives, able to consider different viewpoints and incomplete information to develop effective and actionable next steps.

• Communicate: Managers share the company’s vision, strategies, department goals, and provide necessary information to team members, especially during crises.

• Clarify: Managers define clear expectations, explain what good performance looks like, address performance gaps, and ensure teams understand what is required.

• Coach: Managers offer feedback and recognition, help solve challenges, reinforce positive culture, and support employee performance, growth, and career development.

• Connect: Managers help teams understand their collective purpose and connect their work to the larger organization and its network.

• Customize: Managers recognize individual team member uniqueness and adapt their support and management approach accordingly.

Who we are

The company is an innovative health plan for self-funded employers on a mission to bring affordable, high-quality healthcare to the millions who struggle to pay their healthcare bills. Anchored around a primary care based ACO model, the company saves employers 15 to 30 percent compared to traditional insurance carriers. Employees also realize significant savings through our free primary care (including virtual), predictable copay and no-deductible benefit plan design. The company works with employers ranging in size from 51 employees to Fortune 500 companies. For more information, visit the company [link for members]

Headquartered in Buffalo, NY with offices in New York City and Buffalo, the company is backed by leading healthcare and technology investors, including a recent round of investment from Morgan Health, a business unit of JPMorgan Chase & Co.